On becoming the City of Motherly Love

These deaths are inextricably tied to health inequities. Despite representing only 43% of births in Philadelphia from 2013 – 2018, Black women accounted for 73% of the pregnancy-related deaths over that five-year period. As of 2018, Philly’s infant mortality rate (IMR) mirrored the magnitude of its maternal loss. That year, the rate was 8.1 deaths per 1,000 births, vastly exceeding the national average of 5.8. When parsed by race, larger discrepancies emerge: the city saw 12.5 deaths for every 1,000 Black infants born in 2018. No other racial or ethnic group experienced an IMR higher than the city’s average of 8.1.

While impossible to boil down, research over the last 20 years has helped demonstrate the significant harm that structural racism has inflicted on our mothers and their newborns. The groundbreaking weathering hypothesis shows the cumulative effect that internalized stress caused by structural racism can have on one’s health. This damage is thought to be a key player in the low birthweight rates of Black infants, and in the comparatively high mortality rates of Black mothers.

Importantly for Philadelphia, social determinants of health (SDOH) such as one’s economic potential, a sense of community, and access to healthcare are believed to have an outsized impact on one’s long term health: 80%. While our economy shows signs of health, poverty still impacts many of our residents. 24.5% of the city’s households live below the federal poverty line – the highest of the nation’s ten largest cities. Action plans cannot overlook the gaps in care that poverty helps create.

Recently there has been an increased focus on ensuring equity in access to prenatal care. Early and recurring prenatal visits may offer an opportunity to help prevent unnecessary maternal deaths and improve birth outcomes overall. Despite its importance, prenatal care is not guaranteed: in 2016, nearly one in four women started care late or received fewer than the recommended number of visits. Barriers to prenatal care access run the gamut, from financial difficulties, insufficient insurance coverage, lack of nearby facilities, lack of transportation options, rigid work schedules during office hours, childcare obligations, substance abuse, and more.

The answers are not simple, but providing better, standardized care should be. City sponsored partnerships with community organizations can help fill gaps caused by SDOH. Comprehensive Medicaid access that covers a full spectrum of maternal services, can help reduce the incidence of chronic conditions that result in adverse outcomes. Recently, states, communities, and healthcare providers are joining forces to offer alternate models of care with the sole goal of improving the health of our mothers and infants. The “Healthy PA” expansion in 2015 helps, but still falls short of full access for all families.

Ultimately, it is up to each of us to amplify the shortcomings and inequities we see every day. We know that healthy moms are more likely to have healthy babies. We must extend the same coverage we afford newborns to our women – even prior to conception – in order to more fully transform maternal care. It is up to all of us to make a difference: providers, payers, government leaders, institutions, corporations, and each one of us as individuals. Together, we can help build a brighter future for our mothers and their young ones by ensuring that inequalities don’t become inevitabilities.